Changing epidemiology of HBV infection in Danish children.

Hepatitis B continues to be a worldwide threat to human health, especially if infection occurs in childhood. Universal vaccination is recommended by WHO, but has not been implemented in the Scandinavian countries, Holland and UK, because of a low incidence rate. However, clinically overt infections are rare in childhood. We therefore performed a nation wide serosurvey for HBV markers in 2428 children aged primarily 6-16 years from 16 primary schools in Denmark. Anti-HBc was found in altogether 20 children (0.8%), 12 of whom were among 144 immigrant children (8.3%) compared to 8 (0.4%) in those born in Denmark. Three of the children, all immigrants, were HBsAg positive indicating chronic infection. At school level no relation of anti-HBc in Danish born children was found to schools with high number of immigrant children or schools with HBsAg positive children indicating a low risk of Hepatitis B transmission in this setting. The results do not support implementation of general vaccination, but stress the need for HBV screening in immigrants as it provides a mean for immunization of close contacts at risk and information on prevention.

[Malaria. An evaluation of 127 patients treated in Rigshospitalet in 1999 and 2000]. / Malaria. Opgørelse over 127 patienter behandlet på Rigshospitalet i 1999 og 2000.

INTRODUCTION: The incidence of malaria has increased globally to 500 million cases a year. Imported malaria in travellers comprises only a small fraction, but the disease has become a serious problem in Europe and the United States. The aim of the present study was to elucidate the epidemiological and clinical aspects of patients with imported malaria in Denmark. MATERIAL AND METHODS: All patients treated for malaria at the Department of Infectious Diseases, Rigshospitalet, in 1999-2000 were evaluated retrospectively. Age, sex, nationality, destination, chemoprophylaxis, symptoms, duration of symptoms, parasitaemia, treatment, and complications were registered. RESULTS: Seventy per cent of the patients had falciparum malaria. Of these, 95% had been infected in Africa and 46% of these patients were Africans living in Denmark. Only 50% of all patients had been taking chemoprophylaxis and of these only half had been compliant. Chloroquine and proguanile were most commonly used. Seven patients had parasitaemia above 5%, but only one of these developed complicated malaria. DISCUSSION: The risk of complicated malaria in this series was low and seems to be related to lack of chemoprophylaxis, advanced age, and duration of symptoms.

[Travel prophylaxis among immigrants]. / Rejseprofylakse hos indvandrere.

A female immigrant and her child acquired Plasmodium falciparum infection during a visit to her home country. They did not receive chemoprophylaxis during or after the journey. Immigrants comprise a high risk group for malaria as well as typhoid fever and hepatitis A. Increased attention towards this group of travellers is recommended.

[Collagenous colitis]. / Kollagen colitis.

Collagenous colitis was first described in 1976 by Lindström as an unusual cause of persistent, watery diarrhea. He noted a large subepithelial band of collagen deposited in the rectum and the colon. Collagenous colitis occurs predominantly in females and is more frequent in the elderly. Radiographic examination of the colon is unremarkable, and the patients show no signs of malabsorption. The diagnosis requires biopsy specimens from the colon, as the disease is focal and less frequently affects the rectum. Biopsies taken only from the rectum cannot exclude the diagnosis. For the time being there is no consensus as to the treatment of the disease. We describe two patients with collagenous colitis successfully treated with prednisolone. The diagnostic importance of total colonoscopy with multiple biopsies in a normal-appearing colon in patients with unexplained chronic watery diarrhea is stressed.

[Randomized trial and meta-analysis of somatostatin versus placebo in bleeding esophageal varices]. / Randomiseret undersøgelse og metaanalyse af somatostatin over for placebo ved blødende esophagusvaricer.

We studied whether somatostatin or its derivative, octreotide, is more effective than placebo in the treatment of bleeding oesophageal varices in a randomised, double-blind trial and a meta-analysis with blinded data analysis and manuscript writing. Patients suspected of bleeding from oesophageal varices and of having cirrhosis of the liver were eligible. Eighty-six patients were randomised; 16 died in each group within six weeks (95% confidence interval (CI) for difference in mortality -19% to 22%). There were no differences between somatostatin and placebo in median number of blood transfusions (8 vs 5, p = 0.07, CI 0 to 4 transfusions) or in numbers of patients who needed balloon tamponade (16 vs 13, p = 0.54, CI -11% to 28%). In a meta-analysis of three trials, involving 290 patients, somatostatin had no effect on survival compared with placebo (p = 0.59, odds ratio 1.16, CI 0.67 to 2.01). For blood transfusions and use of balloon tamponade there was heterogeneity between the trials with no convincing evidence in favour of somatostatin.

Isolation rooms for highly infectious diseases: an inventory of capabilities in European countries.

Isolation of patients with highly infectious diseases (HIDs) in hospital rooms with adequate technical facilities is essential to reduce the risk of spreading disease. The European Network for Infectious Diseases (EUNID), a project co-funded by European Commission and involving 16 European Union member states, performed an inventory of high level isolation rooms (HIRs, hospital rooms with negative pressure and anteroom). In participating countries, HIRs are available in at least 211 hospitals, with at least 1789 hospital beds. The adequacy of this number is not known and will depend on prevailing circumstances. Sporadic HID cases can be managed in the available HIRs. HIRs could also have a role in the initial phases of an influenza pandemic. However, large outbreaks due to natural or to bioterrorist events will need management strategies involving healthcare facilities other than HIRs.

Twenty-year survey of the epidemiology of hepatitis B in Denmark: effect of immigration.

Implementation of hepatitis B virus (HBV) vaccination is being considered in Denmark. Therefore, a 20 y survey on the epidemiology of HBV infection was performed. All notified cases of acute HBV infection in Denmark from 1982 to 2002 were reviewed retrospectively and all available data from 1970 to 2001 on the prevalence of hepatitis B surface antigen (HBsAg) in different groups of the Danish population were studied. The notified annual incidence of acute HBV infection has declined from more than 200 cases to fewer than 50 cases in 2001. In the indigenous population there has been a similar decline in prevalence of HBsAg carriers, from 0.15 to 0.03%, but owing to immigration of new HBsAg carriers from developing countries the overall number of carriers has not changed. The small effect of immigration on the incidence of acute HBV infections as well as the decreasing prevalence of HBsAg carriers among Danes should be taken into account when planning new vaccination strategies in Denmark.

Surgical treatment of morbid obesity. A survey of overall outcome 1968-1989.

This survey evaluates benefits and costs from a policy of employing surgical treatment in selected cases of morbid obesity. Between 1968 and 1978, we used end-to-side jejunoileal bypass. Despite many satisfied patients, complications were frequent and severe. For the next decade, we employed various types of gastric surgery. We eventually assessed a gastric balloon, but without success. Median duration of follow-up was 132 months in 145 patients with jejunoileostomy, 103 months in seven gastric bypass patients, and 36 months in 108 gastroplasty patients. Three patients were lost to follow-up. There have been four deaths after intestinal shunt and one after gastroplasty. The median re-admission rate was 1.6 per patient, while the median number of re-operations was 2.0 after intestinal shunt and 0.8 after gastric interventions. The median weight loss in our 260 patients was 32.1% of the preoperative weight. Outcome was good in 38.8%, acceptable in 40.4% and poor in 11.5% while there were 9.2% failures. Truly satisfactory outcomes, however, were rare, owing possibly to a negative relationship between weight loss and complications. Only 8.8% have obtained a stable normal weight without any side-effects.

Dependency of cerebral blood flow on mean arterial pressure in patients with acute bacterial meningitis.

OBJECTIVE: Patients with acute bacterial meningitis are often treated with sympathomimetics to maintain an adequate mean arterial pressure (MAP). We studied the influence of such therapy on cerebral blood flow (CBF). DESIGN: Prospective physiologic trial. SETTING: The Department of Infectious Diseases, Copenhagen University Hospital, Denmark. PATIENTS: Sixteen adult patients with acute bacterial meningitis. INTERVENTION: Infusion of norepinephrine to increase MAP. MEASUREMENTS: During a rise in MAP induced by norepinephrine infusion, we measured relative changes in CBF by transcranial Doppler ultrasonography of the middle cerebral artery, recording mean flow velocity (Vmean), and by the arterial to jugular oxygen saturation difference. In 10 out of 16 patients, serial measurements were performed until recovery or death. Individual autoregulation curves were analyzed by a computer program. Autoregulation was classified as impaired if Vmean increased by >10% per 30 mm Hg increase in MAP and if no lower limit of autoregulation was identified by the computer program; otherwise, autoregulation was classified as preserved. MAIN RESULTS: Initially, Vmean increased from a median value of 46 cm/sec (range, 30-87 cm/sec) to 63 cm/sec (33-105 cm/sec) (p < .0001), and arterial to jugular oxygen saturation difference decreased from 0.28 (0.16-0.51) to 0.21 (0.08-0.39) (p < .001) when MAP was raised from 69 mm Hg (55-102 mm Hg) to 110 mm Hg (93-129 mm Hg). CBF autoregulation was restored in eight of ten patients undergoing serial examination after 7 (range, 2-10) days. Six of these patients had an uncomplicated course, one had a protracted recovery, and one died. Autoregulation was not restored in two patients; one died and one had a protracted recovery. CONCLUSION: In patients in the early phase of acute bacterial meningitis, CBF autoregulation is impaired. With recovery from meningitis, the cerebral vasculature regains the ability to maintain cerebral perfusion at a constant level despite variations in MAP.